Trans-ethnic study confirmed independent associations of HLA-A*02:06 and HLA-B*44:03 with cold medicine-related Stevens-Johnson syndrome with severe ocular surface complications

Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes. Cold medicines including non-steroidal anti-inflammatory drugs and multi-ingredient cold medications are reported to be important inciting drugs. Recently, we reported that cold medicine related SJS/TEN (CM-SJS/TEN) with severe mucosal involvement including severe ocular surface complications (SOC) is associated with HLA-A*02:06 and HLA-B*44:03 in the Japanese. in this study, to determine whether HLA-B*44:03 is a common risk factor for CM-SJS/TEN with SOC in different ethnic groups we used samples from Indian, Brazilian, and Korean patients with CM-SJS/TEN with SOC, and investigated the association between CM-SJS/TEN with SOC and HLA-B*44:03 and/or HLA-A*02:06. We found that HLA-B*44:03 was significantly associated with CM-SJS/TEN with SOC in the Indian and Brazilian but not the Korean population, and that HLA-A*02:06 might be weakly associated in the Korean-but not the Indian and Brazilian population.Ministry of Education, Culture, Sports, Science and Technology of the Japanese governmentJapanese Ministry of Health, Labour and WelfareKyoto Foundation for the Promotion of Medical ScienceIntramural Research Fund of Kyoto Prefectural University of MedicinePromotion Project of Knowledge-Based Industrial Clustering of Okinawa PrefectureKyoto Prefectural Univ Med, Dept Ophthalmol, Kyoto, JapanDoshisha Univ, Fac Life & Med Sci, Res Ctr Inflammat & Regenerat, Kyoto 602, JapanLV Prasad Eye Inst, Prof Brien Holden Eye Res Ctr, Hyderabad, Andhra Pradesh, IndiaUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilSeoul Natl Univ, Coll Med, Dept Ophthalmol, Seoul, South KoreaChonnam Natl Univ, Dept Ophthalmol, Kwangju, South KoreaYonsei Univ, Coll Med, Severance Hosp, Inst Vis Res,Dept Ophthalmol, Seoul, South KoreaCatholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Ophthalmol & Visual Sci, Seoul, South KoreaLV Prasad Eye Inst, Cornea & Anterior Segment Serv, Hyderabad, Andhra Pradesh, IndiaUniv Tokyo, Grad Sch Med, Dept Human Genet, Tokyo, JapanUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

Barriers and enablers for technology diffusion in ophthalmology at not-for-profit advanced eye care institute

Managed care and insurance have penetrated ophthalmic services for patient care and continue to affect outof-pocket spending related to eye care. In such a scenario, understanding technology diffusion is crucial from the perspective of both technology developers as well care providers. Should healthcare organizations choose cheaper technologies or the ones that can be quickly diffused? In this paper, we try to answer this question by reviewing technologies used in the past 10 years across different services in ophthalmology. We generate a framework that bifurcates technologies and provides nomenclature to them based on cost and speed of diffusion. Our work, within its limitations, can provide insights into contemporary technology producers and healthcare organizations.</p

Misleading Goldmann applanation tonometry in a post-LASIK eye with interface fluid syndrome

A 21-year-old myope presented with decreased vision and corneal edema following vitreoretinal surgery for retinal detachment. While intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT) was low, the digital tonometry indicated raised pressures. An interface fluid syndrome (IFS) was suspected and confirmed by clinical exam and optical coherence tomography. A tonopen used to measure IOP through the peripheral cornea revealed elevated IOP which was the cause of the interface fluid. Treatment with IOP-lowering agents resulted in complete resolution of the interface fluid. This case is being reported to highlight the fact that IFS should be suspected when there is LASIK flap edema and IOP readings using GAT are low and that GAT is not an optimal method to measure IOP in this condition. Alternative methods like tonopen or Schiotz tonometry can be used

Calotropis-induced toxic keratitis managed with teleophthalmology services in rural India

A female laborer presented with acute diminution of vision in her right eye following accidental injury with a sap of Calotropis flower. The patient was diagnosed with Calotropis-mediated endothelial toxicity based on clinical findings and started on a course of topical steroids. The patient had to face several logistical challenges such as distance of travel, loss of daily wages, and nonavailability of a family member to accompany her. She was then followed up with sequential imaging of the cornea utilizing the teleophthalmology services of our institute at the rural vision center located in the vicinity of patient's house. Seven days later, the cornea had completely cleared with improvement in the best-corrected visual acuity. This case demonstrates Calotropis-induced endothelial toxicity which is very common in remote rural areas and its effective management using the mobile or tablet-based teleophthalmology application of our institute's three-tier eyecare pyramid model

Contact lens in keratoconus

Contact lenses are required for the visual improvement in patients with keratoconus. Various contact lens options, such as rigid gas permeable (RGP) lenses, soft and soft toric lenses, piggy back contact lenses (PBCL), hybrid lenses and scleral lenses are availble. This article discusses about selection of a lens depending on the type of keratoconus and the fitting philosophies of various contact lenses including the starting trial lens. A Medline search was carried out for articles in the English language with the keywords keratoconus and various contact lenses such as Rose k lens, RGP lens, hybrid lens, scleral lens and PBCL

Phototherapeutic keratectomy

Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this article is to discuss the therapeutic indications for PTK, the specific technique pertaining to a specific etiology, the various other procedures like amniotic membrane graft combined with PTK or PTK being done for recurrences in the grafts, and PTK done before cataract surgery when the anterior corneal pathology coexists with the cataract. Post PTK management such as healing of an epithelial defect, use of steroids in the post PTK period, recurrences of primary disease pathology, and infections, will be discussed. Methods of literature search: A Medline search was carried out for articles in the English language, with the keywords, phototherapeutic keratectomy, band-shaped keratopathy, spheroidal degeneration, scars, bullous keratopathy, and corneal dystrophy. The relevant references are mentioned here

Anterior megalophthalmos: Is visual restoration possible?

We report two cases of anterior megalophthalmos with cataract. Both cases have megalocornea, cavernous anterior chamber, enlarged iris–lens diaphragm, and normal axial length. The vision was less due to cataract. To restore vision, phacoemulsification was performed in each eye in both cases. Intraoperatively, to overcome anatomical challenges, we made scleral tunnel incision, stained anterior capsule, and fixated intraocular lens (IOL) by different techniques. In the first case, IOL was fixated through the sclera, whereas in the second case, IOL stabilization was achieved by capturing the optic in anterior capsulorhexis margin and placing the haptics in sulcus. Successful vision was restored in both cases without pseudophacodonesis

The sting of a honey bee: An unusual subconjunctival foreign body

Ocular foreign bodies (FBs) are often encountered in clinical practices. However, there are cases in which the presence of the FB is difficult to diagnose based on mere history taking and/or clinical examination. We herein present a case of unusual subconjunctival foreign body in the form of the sting of a honey bee in a 63-year-old farmer. This was removed from the superior forniceal subconjunctival space in toto with forceps under a microscope in the operation theater. This case emphasizes the need to elicit a complete history and a careful ocular examination with double eversion of the eyelid to avoid missing any foreign body lodged in the fornices and subconjunctival space in patients who complained of foreign body sensation

Late occurrence of granular dystrophy in bilateral keratoconus: Penetrating keratoplasty and long-term follow-up

We report a rare case of keratoconus with granular dystrophy with a follow-up of two decades, documenting the sequential presentation of two diseases confirmed by histology and genetic studies. A 13-year-old boy was diagnosed in 1988 with keratoconus in both eyes (BE) based on slit-lamp biomicroscopy findings of corneal ectasia in BE accompanied by Fleischer's ring, Vogt's striae, a small, old, healed hydrops. The left eye (LE) had central corneal thinning and scar in the central area involving the mid and posterior stroma secondary to healed hydrops. Penetrating keratoplasty (PKP) was advised. The boy was lost to follow-up till 1991 and presented with white, dot-like opacities in the central cornea in the RE only, suggestive of granular corneal dystrophy. Similar findings of white, dot-like opacities were noted in the LE in 1995 and the patient subsequently underwent PKP in BE. Histopathology of corneal buttons confirmed the presence of patchy, crystal-like orange deposits, which stained bright red with Masson's trichrome. Mutational analysis of the TGFBI gene in patient's DNA revealed a heterozygous mutation corresponding to a change in Arg555Trp in the keratoepithelin protein. Granular dystrophy recurred after 8 years in the RE